71: Early gestational diabetes screening based on ACOG guidelines

Abstract

A recent randomized controlled trial suggested that early gestational diabetes (GDM) screening in women with obesity (BMI≥30) does not improve outcomes. ACOG currently recommends early screening for gestational diabetes in women who are obese with one or more additional risk factors (Table 1). We evaluate whether early screening in patients with additional risk factors improves pregnancy outcomes. This was a secondary analysis of a multi-center randomized controlled trial of obese women with singleton non-anomalous gestations comparing early GDM screening (14-20wga) to routine (24-28wga). Exclusion criteria were pregestational diabetes, major medical illnesses, bariatric surgery, and prior cesarean. Primary outcome was an adverse perinatal composite outcome composite (Table 1). Randomization groups were compared, stratified by the number of additional risk factors for GDM (0, 1, 2, ≥3). Chi squared test of association was performed for categorical measures with relative risks calculated for outcomes. Breslow-Day test was used to test interaction between randomization group and gestational age at the time of GDM screen. Secondary outcome was incidence of the primary outcome and GDM by number of additional risk factors (chi-squared test for trend). Of 913 women, 5% had 0, 52% had 1, 33% had 2, and 10% had ≥3 additional risk factors. Baseline characteristics, including number and type of risk factors, were similar between early and routine screening groups. Early screening (compared to routine screening) was not associated with a reduction in the adverse perinatal composite regardless of number of additional risk factors present (Table 1), although the incidence of GDM and the adverse perinatal composite outcome increased as the number of risk factors increased (Table 2, p< 0.001). Breslow-Day test for interaction was not significant for either the primary outcome (p=0.37) or GDM (p=0.28). In women with BMI≥30 and additional risk factors, early GDM screening is not beneficial. Recommendations for early GDM screening in this population should continue to be evaluated.View Large Image Figure ViewerDownload Hi-res image Download (PPT)